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ELECTRICAL.INSPECTOR RECORD
<br />APPBOVALS DATE COMMENTS
<br />-l-
<br />dwi.i.rrh. pmpcny, or mycDploycc\ *nh wagc. as rhct $lc conrl(nsllion- eilldo lhe wol( &d Ihc sltrlur is nur
<br />idc,xld or.l1!rcd for s,lc (Ss r04,l. Busirc$.nd Pmicsnrns Codc:-lhc Gn racl{,\l-i.ctscLtwdocsnot0ptlyhMowncrol
<br />rhc loFdy *ho hoikts or nryn)tr rhLrs,n. ml s}x) dtrs skh wo* hnntlfor hfsclfor lhrcuah hh or hcr own cnrployccs.
<br />povi.lcd lh such nn nvcnrnls !rc not inrcndsl or dtu lhr slc li hokls, r}r btildnE or i']W ownEnl is sll wilhin r. ttr
<br />.l co'ryLridr rtr ONno Builds will luw th. hnrd.n of pmvinS lh{ hc or shc dil mr huiH o, in{mt rhc F,pcny for rhc l)uF't ol
<br />-1.Nowrcrofth.ImFny.amcrclusivclyconrading*irhliccnscdco,ermro..nsrudilEpoid(Scc.rO{4.Businc$lrd BoG.iin Code: Th. Co.rturor's Li..ns. hw des not apply io m owncr or prc,:cn, who buildr or inprovcs lhcrcon.
<br />rnd qho onrr.ds for such pmids *ilfi a Conrocro(s) lienscd Du^unr ro rh. Conlractoas Liers Law).
<br />I amcrcmDr uRlcr Sc.tFn .B &PC fo,rhi.m{n
<br />Dere: O*ftr'-
<br />-loxtrE[s:g)MtE[alla!p&c!A!.uoN
<br />I hcrcby amrmundcr penalty of pcriury orc ollhe lollowins dtluarionsl
<br />-l
<br />havc o"d will minroin aCcnificor..f Con* t Selt lnsxe ror wx.rs .onlrns.lion. as povided tor by Scc'ion.1700 orrh.
<br />bhor Cod.. for lhc perfomnce of lhc *ort for vhkh lhe pohn h hru.d
<br />_l hrw ond will naim n wollc^ conD.nssrion irsuramc. 8 rcquircd b! S61ion :1700 or dt l2b.r Co&, for rh. Frfomra of
<br />$hichrhnp.nnir s ssrcd My workcr'c.rrpctr\rrnrn insurrmc ciricr uxl rxnicy nnmb.r c:
<br />Y(
<br />I ccnify rhrr in rh. Nrtunhn.c ofrhc work tu shi.h rhr Jt'oril i\ is{'.i|. I shrll mr cDdoy rtry pcrnr 1n rny n'rnncr
<br />{i hhd rshicdnrihcwor[r'ico rpci'fi,nr lrws ofcrlitunrii. (ld8rcrh ilIshoutd h.onc {hid t,rhc
<br />$orkcr\ $m|Inunr pi.vi\ionsol Sc(rnr l7U)oflhc Llh, C'(lc.l\1I'11tu'rhwirhromp]y*irhrln^c Pr visi(rs
<br />to onc hufttrci rlxru\u dolhrs (SI(X).U]O), rddiri(rr h rhc .o{ ofcorpcnsarion- droBgcs r\ ttuv .d Lr rhc
<br />s(riLn 3r)76nl rltr l rhtr (i,J. n .'d( rklr(
<br />c 1/8
<br />DECI,AXAIIA!
<br />I h.rh, amnn undcr p.ndhy of p.riury rhar I sm lietrsd undcr rolision of Chaprer 9 (omm.cing wilh Setion ?OO0) o{Dilhion l
<br />of rhc Blsimss lnd Phfesrion{ Cod., dd ny liccnk k in tull loro ord cftel
<br />G (oc\lq3
<br />?/D t
<br />cl)! alJ(:IlaNrllltlc-AlilNcr
<br />I turcby rfiirmundcr rEnllryoar--rjtrr, rhlr rhod i\ tr.on{rucri.n LMnE,EcNy |or rhc pcrlolrume ofrh. solk rot !hn'h rhis rcilni is
<br />is cd (sN lo9r.civ c.)
<br />A.TTUCANLDECI.AAAfION
<br />I lr[$y dtn m undcr pctrrlty oltcrjry otrc ol lhc rhllo*in8 dcclnrurion\:
<br />Dcmririon Pcrnih sbcskr Notilicdnr FcdcrilRc8ularions (Titlc 4(J- l,rn6)
<br />R.qrtrcd kncr ol Norifi .rli({l
<br />-l
<br />ccnify rbat lhc ,cdcral reElLr jonr rcs,rdins *b.tus r.mvd dn mr {rlic0blc to rhis !,oFcr.
<br />:11.cnify rhar I haw cnd this appliolion 0,r.1 atc lhal trk atrvc infomlion iscomr I ryrc i. .onply *nh .ll Cny and Coury
<br />orditurr$ dnd starc Li*s mhrine to buildin8 constMrbr ond hcrcby Mthoria Eprkn(div.s orlht Cily md County lo cnrcr opon tlr'!),)).),iT-IXi"VWu *-. /,,1f
<br />Prmx*mne,pdr,,, ( 1 tfs,er, Ei+tn
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lite Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Translormers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinos (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rough)
<br />Rough
<br />Service It/eler (t )
<br />FINAL tlq t9 ,{/4qrF
<br />Noles, Remarks, Etc
<br />,I
<br />-t
<br />ID/SIG.
<br />Site-Work
<br />Ivleter Release
<br />OWNER BT'TI-DER DEI,CARATION
<br />I lErcby ifiii,n u.dcr Foahy r'' pcrj!ry rhar I !n cic'npr ton rhc C.r(d.k,6 Lic.tr* bv for thc followin8 rclsn lscc 70:ll 5
<br />tlusinc$ and Prorcssn,n Code, Any Cily .r Counry shth rcqut.s N Fnhn ro snslrucl, rltcr. improvc dcw,lth or FIan any
<br />ntucrlrc. rirro irr iasulkc, aho rcquircs r h. {rltconl ror such ,rirnn ro filc o sistr.n slalcmnl rtur hc or rhc n c.nicd lifr\xMr
<br />ro thc pmvni.ns ofltE Co,l.aclorr l,iccnscd Liw (Clnprcr 9. Cootftn.ins wirh sc.ri,Dn 7000 oi Divisiotr 3 oI rhc Bu\ioesr 8nd
<br />P!'tcsn,ns Codc) or rbd ri.r shc i\ crcnpr rh.r.ton dd ih. bost lor lhc allcscd cxcmltion Any vk,hrn,nors(rion70rl5 hy rny
<br />rrpliont fo. a pcn.it suhj(lslhc apflicanlro ocivilpc.ullyolnor mor. rhnn fivc hx.drM dollds($5fi))
<br />.-,."o*,y'.r
<br />lf,nd.i s Addrcs
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